Provider Demographics
NPI:1497440770
Name:ADAPT & GROW LLC
Entity Type:Organization
Organization Name:ADAPT & GROW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BALOG
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:804-476-4389
Mailing Address - Street 1:11406 HOMESTEAD LN
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4618
Mailing Address - Country:US
Mailing Address - Phone:703-346-5931
Mailing Address - Fax:
Practice Address - Street 1:11406 HOMESTEAD LN
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-4618
Practice Address - Country:US
Practice Address - Phone:804-476-4389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1558804062Medicaid
VA1124485982Medicaid
VA1881055341Medicaid